Antibiotic resistance patterns of methicillin-resistant coagulase negative staphylococci isolated from blood cultures at a university hospital in Turkey

Aims@#Recent reports indicate that many coagulase-negative staphylococci (CoNS) strains are resistant to most antimicrobials used against staphylococcal infections. This study was aimed to determine the species distribution of the CoNS isolates in Lokman Hekim Ankara Hospital and determine their antimicrobial resistance characteristics.@*Methodology and results@#The study was conducted at Lokman Hekim University Ankara Hospital between February 2020 and August 2021. The 154 blood cultures included in the study were incubated in the BACTEC FX40 automated blood culture device. Identification and antimicrobial susceptibility tests of the samples with positive catalase tests were performed with the BD Phoenix Automated Microbiology Sensitivity System. The statistical significance level was accepted as p<0.05. Nineteen different types of methicillin-resistant coagulase-negative staphylococci (MRCoNS) isolated from different age groups were identified. Vancomycin resistance was observed in 20 samples (13%). Trimethoprim-sulfamethoxazole (TMP-SMX) resistance was seen in 44 of 152 samples (28.6%), linezolid resistance in 15 of 143 samples (10.5%) and daptomycin resistance in 16 of 146 blood samples (11%).@*Conclusion, significance and impact of study@#In our investigation, there has been a striking rise in the prevalence of vancomycin, TMP-SMX, linezolid and daptomycin resistance among infections with the MRCoNS. Identifying and classifying multidrug resistance on MRCoNS requires reliable epidemiological data to be collected and compared between healthcare facilities in different countries. The research finding reported in this paper will contribute to the determination of alternative antibiotics for treating MRCoNS.

Predictors of acute neurological complication following tetralogy of Fallot operation in Serdang Hospital, Malaysia

@#Background: The long waiting time for Tetralogy of Fallot (TOF) operation may potentially increase the risk of hypoxic insult. Therefore, the objective of this study is to determine the frequency of acute neurological complications following primary TOF repair and to identify the peri-operative risk factors and predictors for the neurological sequelae. Methods: A retrospective review of the medical and surgical notes of 68 patients who underwent TOF repair in Hospital Serdang, from January 2013 to December 2017 was done. Univariate and multivariate analyses of demographics and perioperative clinical data were performed to determine the risk for the development of acute neurological complications (ANC) among these patients. Results: ANC was reported in 13 cases (19.1%) with delirium being the most common manifestation (10/68, 14.7%), followed by seizures in 4 (5.9%) and abnormal movements in two patients (2.9%). Univariate analyses showed that the presence of right ventricular (RV) dysfunction, prolonged duration of inotropic support (≥7 days), prolonged duration of mechanical ventilation (≥7 days), longer length of ICU stays (≥7 days), and longer length of hospital stay (≥14 days), were significantly associated with the presence of ANCs (p<0.05). However, multivariate analyses did not show any significant association between these variables and the development of ANC (p>0.05). The predictors for the development of postoperative delirium were pre-operative oxygen saturation less than 75% (Odds Ratio, OR=16.90, 95% Confidence Interval, 95%CI:1.36, 209.71) and duration of ventilation of more than 7 days (OR=13.20, 95%CI: 1.20, 144.98). Conclusion: ANC following TOF repair were significantly higher in patients with RV dysfunction, in those who required a longer duration of inotropic support, mechanical ventilation, ICU and hospital stay. Low pre-operative oxygen saturation and prolonged mechanical ventilation requirement were predictors for delirium which was the commonest neurological complications observed in this study. Hence, routine screening for delirium using an objective assessment tool should be performed on these high-risk patients to enable accurate diagnosis and early intervention to improve the overall outcome of TOF surgery in this country

Factors Influencing Disconnection Hyperprolactinemia and Reversal of Serum Prolactin after Pituitary Surgery in a Non-Functioning Pituitary Macroadenoma

Background: To investigate factors influencing disconnection hyperprolactinemia, including tumour volume, degree of pituitary stalk displacement and extent of tumour growth based on a modified Wilson-Hardy classification in a non-functioning pituitary macroadenoma and to confirm reductions in serum prolactin levels after endoscopic transphenoidal surgery. Methods: This prospective, descriptive study was conducted in the Department of Neurosurgery, General Hospital Kuala Lumpur from Jan 1, 2011 to Jan 1, 2013. Forty patients fulfilling the inclusion criteria were enrolled. All patients underwent endoscopic transphenoidal resection of non-functioning pituitary macroadenoma. Pituitary stalk angle, tumour volume and extent of tumour growth were measured from Magnetic Resonance Imaging (MRI) pre- and post-operatively. These variables were compared to serum prolactin levels measured pre and post operatively. SPSS 21 was used to perform statistical analyses. Results: In 40 patients, the mean tumour volumes were 10.58 cm3 (SD 7.81) pre-operatively and 3.1 cm3 (SD 3.45) post-operatively. There was a 70% reduction in tumour volume post-operatively (P < 0.01). The mean serum prolactin was 457 mIU/L (SD 66.93) pre-operatively and 297 mIU/L (SD 6.73) post-operatively. There was a 65% reduction in prolactin serum levels after surgery (P < 0.01). The mean pituitary stalk angles were 93.45 ± 3.89 degrees pre-operatively and 51.45 ± 1.46 degrees post-operatively (P = 0.01). The mean pituitary stalk angle in the control group was 50.4 ± 8.80 degrees. Hence, there was a 98% reduction in pituitary stalk angle after surgery (P < 0.01). This study showed a linear correlation between the pre-operative and post-operative tumour volumes and serum prolactin levels (P = 0.01 pre-and post-operative) and between serum prolactin levels and pituitary stalk angle (P = 0.20 pre-operative; P = 0.01 post-operative). Conclusion: Tumour volume and pituitary stalk angle displacement have positive predictive values for disconnection hyperprolactinemia in non-functioning pituitary macroadenoma. However, a larger sample size and further objective studies are needed to confirm these findings.

Knowledge of Primary Health Care Providers in Nairobi East District, Kenya, Regarding HIV-related Oral Facial and Other Common Oral Diseases and Conditions.

Background: In the Kenya primary health care (PHC) setting where most patients, including nearly 1.4 million HIV-infected people, seek medical care, PHC providers are expected to identify and manage HIV-related oral diseases during general consultations. This study aimed to assess the current knowledge of clinical officers and nurses in Nairobi East district of Kenya regarding HIV-related oral diseases and conditions. Design and Methods: A 40-item questionnaire was used in interviewing all 57 PHC providers in 2 administrative divisions in the district in a cross-sectional survey. Assessed categories were: knowledge about HIV-related oral lesions, clinical appearance of HIV-suspected conditions, knowledge about oro-pharyngeal candidiasis (OPC), general dental knowledge, common appearances of OPC, knowledge about periodontitis, causes of dental caries, frequency of general oral examinations and past training in oral health topics. The first 4 categories were confirmed as sub domains, with Cronbach’s alpha of 0.57, 0.54, 0.59 and 0.45 respectively. Results: All 57 PHC providers (15 clinical officers and 42 nurses) completed the questionnaire (response rate 100%). PHC providers did not routinely perform oral examinations. Their knowledge about HIV-related oral health topics and general oral health was found to be generally inadequate. Recommendations: A training module on HIV-related oro-facial lesions for Nairobi PHC providers, incorporating a practical session covering oral examinations, is recommended; especially in this high HIV-prevalence environment.

Self-Reported Recovery from 2-Week 12-Hour Shift Work Schedules: A 14-Day Follow-Up

BACKGROUND: Recovery from fatigue is important in maintaining night workers' health. This study compared the course of self-reported recovery after 2-week 12-hour schedules consisting of either night shifts or swing shifts (i.e., 7 night shifts followed by 7 day shifts) to such schedules consisting of only day work. METHODS: Sixty-one male offshore employeesd-20 night workers, 16 swing shift workers, and 25 day workersdrated six questions on fatigue (sleep quality, feeling rested, physical and mental fatigue, and energy levels; scale 1-11) for 14 days after an offshore tour. After the two night-work schedules, differences on the 1st day (main effects) and differences during the follow-up (interaction effects) were compared to day work with generalized estimating equations analysis. RESULTS: After adjustment for confounders, significant main effects were found for sleep quality for night workers (1.41, 95% confidence interval 1.05-1.89) and swing shift workers (1.42, 95% confidence interval 1.03-1.94) when compared to day workers; their interaction terms were not statistically significant. For the remaining fatigue outcomes, no statistically significant main or interaction effects were found. CONCLUSION: After 2-week 12-hour night and swing shifts, only the course for sleep quality differed from that of day work. Sleep quality was poorer for night and swing shift workers on the 1st day off and remained poorer for the 14-day follow-up. This showed that while working at night had no effect on feeling rested, tiredness, and energy levels, it had a relatively long-lasting effect on sleep quality.

Pharmacokinetics of fexofenadine in healthy Taiwanese volunteers

The aim of presented study was to assess pharmacokinetic properties of fexofenadine in Taiwanese volunteers. iniv-three healthy male subjects received 180mg fexofenadine. Blood samples were drawn at appropriate times

Drug concentrations of fexofenadine were measured by a LC/MS/MS method. Non-compartmental models were applied to ribe the pharmacokinetic characters of fexofenadine. After oral administration of fexofenadine, the T[max] was :81h. The C[max] 703.76+/-298.94ng/mL and AUC[0.00] was 4582.52+/-1812.59hxng/mL. The elimination half-life of lenadine was 12.18+/-3.61h. One of the most important determinants was to prove the similar results in the pharmacokinetics of fexofenadine in Taiwan subjects compared with the reported data of other ethnic origin

Subtelomeric chromosomal rearrangements in a large cohort of unexplained intellectually disabled individuals in Indonesia: A clinical and molecular study.

CONTEXT: Unbalanced subtelomeric chromosomal rearrangements are often associated with intellectual disability (ID) and malformation syndromes. The prevalence of such rearrangements has been reported to be 5-9% in ID populations. AIMS: To study the prevalence of subtelomeric rearrangements in the Indonesian ID population. MATERIALS AND METHODS: We tested 436 subjects with unexplained ID using multiplex ligation dependent probe amplification (MLPA) using the specific designed sets of probes to detect human subtelomeric chromosomal imbalances (SALSA P070 and P036D). If necessary, abnormal findings were confirmed by other MLPA probe kits, fluorescent in situ hybridization or Single Nucleotide Polymorphism array. RESULTS: A subtelomeric aberration was identified in 3.7% of patients (16/436). Details on subtelomeric aberrations and confirmation analyses are discussed. CONCLUSION: This is the first study describing the presence of subtelomeric rearrangements in individuals with ID in Indonesia. Furthermore, it shows that also in Indonesia such abnormalities are a prime cause of ID and that in developing countries with limited diagnostic services such as Indonesia, it is important and feasible to uncover the genetic etiology in a significant number of cases with ID.

Population dynamics of the migratory fish Prochilodus lineatus in a neotropical river: the relationships with river discharge, flood pulse, El Niño and fluvial megafan behaviour

The relative importance of flood pulse dynamics and megafan behaviour for the Sábalo (Prochilodus lineatus) catches in the neotropical Pilcomayo River is studied. The Sábalo catches can mainly be explained by decreased river discharges in the preceding years resulting in smaller inundated areas during rainy season floods and thereby in a decreased area of feeding grounds for the fishes. The decreased river discharges and the related decline of Sábalo catches in the 1990's can be linked to the 90-95 El Niño event. In 2007 the Sábalo catches were comparable to the catches before the "El Niño" event. The connectivity (continuity) between the main river and flood plain areas, which is influenced by sedimentation processes, is also of great importance and very probably plays a more important role since the late 1990's.

Se ha estudiado la importancia relativa de la dinámica del pulso de inundación y el comportamiento del sistema megafan para las capturas del Sábalo (Prochilodus lineatus) en el río Pilcomayo. Las capturas del Sábalo puede explicarse fundamentalmente por los bajos caudales del río en los años anteriores, resultando en menores superficies de las zonas inundadas durante la temporada de lluvia y por lo tanto en una área menor de alimentación para los peces. La disminución del caudal del río y la declinación relativa de capturas de Sábalo en los años 1990 pueden estar relacionadas con el 90-95 evento de El Niño. En 2007, la captura de Sábalo fue comparable a las capturas antes del evento de "El Niño". La conectividad (continuidad) entre el río principal y las llanuras aluviales, que son influenciadas por los procesos de sedimentación, son también de gran importancia y muy probablemente juegan un papel muy importante desde finales de los años '90.

Reformas de la atención médica orientadas al mercado: tendencias y opciones futuras / Medical attention reforms: tendencys and future options

En muchos sistemas de atención médica financiados predominantemente con recursos públicos se han implementado o han sido propuestas reformas orientadas al mercado. El propósito de estas reformas es hacer más eficiente, más innovadora y más sensible a las preferencias de los consumidores la asignación de recursos en atención médica, mientras se conserva la equidad. Al mismo tiempo, los avances en tegnología resultan en una divergencia de las preferencias de los consumidores con respecto a la tención médica y la sociedad percibe la urgencia de volver a pensar el significado del principio de solidaridad en atención médica. En este artículo indicamos algunas tendencias internacionales en las reformas de la atención médica y exploramos algunas potenciales opciones futuras

¿Es la resistencia a la insulina la causa del inadecuado control en diabéticos?: análisis situacional / Is resistance to insulin the cause of inadequate control?

La diabetes mellitus es un síndrome caracterizado por hiperglucemia debida a un amplio conjunto de anormalidades fisiológicas, que producen básicamente un trastorno en el metabolismo de la glucosa. En el Instituto Mexicano del Seguro Social (IMSS), se ha venido desarrollando un programa específico para la diabetes mellitus no dependiente de insulina (DMNID) tendiente a la detección oportuna de este padecimiento, lograr un adecuado manejo y control, prevenir complicaciones y/o limitar el daño, por lo que en el presente artículo se analiza el estado en que se encuentran los diabéticos adscritos al turno matutino de la Unidad de Medicina Familiar No. 18. En el momento actual se requiere de actualización y capacitación del personal en cuanto al síndrome de resistencia a la insulina (SRI), y la antropometría adecuada para valorar cambios en el organismo, así como que los laboratorios de las unidades de medicina familiar cuenten con la infraestructura necesaria para la determinación de hemoglobina glicosilada, microalbuminuria y que los resultados del colesterol estén debidamente avalados. Por otra parte, debe hacerse hincapié, una vez más, en la importancia de programas educativos adecuados, tendientes primero a la identificación de hábitos, conductas y actitudes inadecuadas, para posteriormente abocarse a la modificación de las mismas, modelo que requiere un cambio en la relación médico-paciente y en especial en la relación con el equipo